=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942468293
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ABBY FAYE FLEISCH MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/22/2008
-----------------------------------------------------
Last Update Date | 03/26/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 887 CONGRESS ST
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04102-3100
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-662-5522
-----------------------------------------------------
Fax | 207-662-5526
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 887 CONGRESS ST
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04102-3100
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-662-5522
-----------------------------------------------------
Fax | 207-662-5526
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | MD21316
-----------------------------------------------------
License Number State | ME
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 243353
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 2080P0205X
-----------------------------------------------------
Taxonomy Name | Pediatric Endocrinology Physician
-----------------------------------------------------
License Number | 243353
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 2080P0205X
-----------------------------------------------------
Taxonomy Name | Pediatric Endocrinology Physician
-----------------------------------------------------
License Number | MD21316
-----------------------------------------------------
License Number State | ME
-----------------------------------------------------